Guanzon Anna, Heit Michael, Khoder Waseem
From the Department of Obstetrics and Gynecology and.
Division of Female Pelvic Medicine and Reconstructive Surgery, Indiana University, Indianapolis, IN.
Female Pelvic Med Reconstr Surg. 2018 Nov/Dec;24(6):412-418. doi: 10.1097/SPV.0000000000000474.
Determine if anteroposterior genital hiatus (GH) widening obscures rather than facilitates signs and symptoms, inadvertently altering management decisions for women with pelvic organ prolapse (POP) during Valsalva's Maneuver, at a given total vaginal length (TVL).
We performed a retrospective cohort with nested cross-sectional study of patients who underwent POP surgery. Data from obstetric and gynecologic history, preoperative and postoperative physical examinations, and 20-item Pelvic Floor Distress Inventory (PFDI-20) and 7-item Pelvic Floor Impact Questionnaire (PFIQ-7) scores were extracted. Study participants were compared in 2 groups: anteroposterior widened (>3 cm) and not widened (≤3 cm) GH, for baseline leading edge and POP stage, while controlling for TVL. Baseline PFDI-20 and PFIQ-7 scores were evaluated within GH groups. Delta GH, PFDI-20, and PFIQ-7 scores after apical suspension with and without posterior colporrhaphy were compared to assess the clinical value of the procedure.
Study participants with anteroposterior GH widening during Valsalva maneuver had greater baseline leading edge descent and higher POP stage compared with those without anteroposterior GH widening after controlling for TVL. Baseline PFDI-20 and PFIQ-7 scores were similar within both GH categories controlling for prolapse severity. Adding posterior colporrhaphy to apical suspension resulted in a greater anteroposterior GH reduction without improving delta PFDI-20 or PFIQ-7 scores.
Facilitation through herniation rather than obscuration from anteroposterior GH widening explains why patients will not be undertreated based on signs and symptoms of disease. Adding posterior colporrhaphy to apical suspension more effectively reduces anteroposterior GH widening without differential improvement in symptoms rendering the operation to no more than a cosmetic procedure.
确定在给定的总阴道长度（TVL）下，在瓦尔萨尔瓦动作期间，前后向生殖裂孔（GH）增宽是否会掩盖而非促进体征和症状，从而无意中改变盆腔器官脱垂（POP）女性的治疗决策。
我们对接受POP手术的患者进行了一项回顾性队列研究，并进行了嵌套横断面研究。提取了妇产科病史、术前和术后体格检查以及20项盆底困扰量表（PFDI - 20）和7项盆底影响问卷（PFIQ - 7）评分的数据。研究参与者分为两组：前后向增宽（>3 cm）和未增宽（≤3 cm）的GH组，比较其基线前缘和POP分期，同时控制TVL。在GH组内评估基线PFDI - 20和PFIQ - 7评分。比较在有和没有后阴道壁修补术的顶端悬吊术后GH、PFDI - 20和PFIQ - 7评分的变化，以评估该手术的临床价值。
在控制TVL后，与瓦尔萨尔瓦动作期间前后向GH未增宽的患者相比，前后向GH增宽的研究参与者基线前缘下降更大，POP分期更高。在控制脱垂严重程度的情况下，两个GH类别中的基线PFDI - 20和PFIQ - 7评分相似。在顶端悬吊术中加做后阴道壁修补术可使前后向GH更大程度地缩小，但并未改善PFDI - 20或PFIQ - 7评分的变化。
通过疝出促进而非前后向GH增宽导致的掩盖可以解释为什么患者不会因疾病的体征和症状而接受不充分的治疗。在顶端悬吊术中加做后阴道壁修补术能更有效地减少前后向GH增宽，但症状改善无差异，使得该手术仅相当于一种美容手术。
